Journal of the American Academy of Child & Adolescent Psychiatry
RESEARCH UPDATE REVIEWYouth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years
Section snippets
OVERALL RATES AND SECULAR PATTERNS
Suicide was the third leading cause of death among 10- to 14-year-olds and 15- to 19-year-olds in the United States in 2000 (Anderson, 2002). While the rates of completed suicide are low (1.5 per 100,000 among 10- to 14-year-olds and 8.2 per 100,000 among 15- to 19-year-olds), when nonlethal suicidal behavior and ideation are taken into account, the magnitude of the problem becomes obvious. The surge of general population studies of suicide attempts and ideation has yielded reliable estimates
Psychopathology
More than 90% of youth suicides have had at least one major psychiatric disorder, although younger adolescent suicide victims have lower rates of psychopathology, averaging around 60% (Beautrais, 2001;Brent et al., 1999;Groholt et al., 1998;Shaffer et al., 1996). Depressive disorders are consistently the most prevalent disorders among adolescent suicide victims, ranging from 49% to 64% (Brent et al., 1993a;Marttunen et al., 1991;Shaffer et al., 1996). The increased risk of suicide (odds ratios)
Family Cohesion
Family cohesion has been reported as a protective factor for suicidal behavior among adolescents in a longitudinal study of middle school students (McKeown et al., 1998) and cross-sectional community studies of high school (Rubenstein et al., 1989, Rubenstein et al., 1998) and college students (Zhang and Jin, 1996). Students who described family life in terms of a high degree of mutual involvement, shared interests, and emotional support were 3.5 to 5.5 times less likely to be suicidal than
PREVENTION STRATEGIES
Youth suicide prevention strategies have primarily been implemented within three domains—school, community, and health-care systems—and generally have one of two general goals: case finding with accompanying referral and treatment or risk factor reduction (CDC, 1994;Gould and Kramer, 2001).
TREATMENT
Recent reviews (e.g., Hawton et al., 1998, Hawton et al., 2002;Rudd, 2000) note that few studies have systematically evaluated interventions aimed at reducing suicidal ideation and behavior in children and adolescents, i.e., randomized controlled trials that obtain reliable and valid measures of outcome variables during pretreatment, posttreatment, and follow-up periods. Most treatment efficacy studies of adolescent psychiatric populations exclude suicidal individuals, possibly because the
CONCLUSIONS
The past decade has witnessed a surge in research on youth suicide risk. The current review has underscored youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms as key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Factors that had been previously thought to be risks for youth suicide, such as divorce and
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The expert assistance of Margaret Lamm in the preparation of this manuscript is gratefully acknowledged.